Tribes and Indigenous Peoples

Physical, Mental, and Indigenous Values-Based Health at Risk

Indigenous health is based on interconnected social and ecological systems that are being disrupted by a changing climate. As these changes continue, the health of individuals and communities will be uniquely challenged by climate impacts to lands, waters, foods, and other plant and animal species. These impacts threaten sites, practices, and relationships with cultural, spiritual, or ceremonial importance that are foundational to Indigenous peoples’ cultural heritages, identities, and physical and mental health.

Physical health risks and impacts to Indigenous peoples are the same as those faced by the general U.S. population (Ch. 14: Human Health); however, certain factors, known as the social determinants of health, are unique and contribute to the increased vulnerability of Indigenous peoples to adverse and potentially severe or fatal health outcomes (Box 15.1). Conventional Western science approaches to measuring and analyzing Indigenous health, adaptive capacity, health disparities, and environmental justice issues typically do not capture many of the key elements of health and resilience that are important to Indigenous populations.81,82,83,84,85,86 These elements emphasize non-physiological aspects of health, which include concepts related to community connection, natural resources security, cultural use, education and knowledge, self-determination and autonomy, and resilience.83,84 For example, the Swinomish Indian Tribal Community has used shellfish beds and shoreline armoring as indicators to evaluate health in the context of a changing climate.81

Box 15.1: Social Determinants of Indigenous Health

A number of health risks are higher among Indigenous populations due in part to historic and contemporary social, political, and economic factors that can affect conditions of daily life and limit resources and opportunities for leading a healthy life.87 Many Indigenous peoples still experience historical trauma associated with colonization, removal from their homelands, and loss of their traditional ways of life, and this has been identified as a contributor to contemporary physical and mental health impacts.88,89 Other factors include institutional racism, living and working circumstances that increase exposure to health threats, and limited access to healthcare services.87,89 Though local trends may differ across the country, in general, Indigenous peoples have disproportionately higher rates of asthma,90 cardiovascular disease,91,92,93,94 Alzheimer’s disease or dementia,95,96 diabetes,97 and obesity.93 These health disparities have direct linkages to increased vulnerability to climate change impacts, including changes in the pollen season and allergenicity, air quality, and extreme weather events (Ch. 14: Human Health).98 For example, diabetes prevalence within federally recognized tribes is about twice that of the general U.S. population.97 People with diabetes are more sensitive to extreme heat and air pollution, and physical health impacts can also influence mental health.98

Indigenous peoples have a unique and interconnected relationship with the natural environment that is integral to their place-based social, cultural, and spiritual identity; intangible cultural heritage (traditions or living expressions transmitted and inherited through generations); and subsistence practices and livelihoods.61,82,87,99,100 Climate change impacts to ecosystems (Ch. 7: Ecosystems) alter the relationships between humans and animals, between individuals, and within and between communities; these relationships are central to Indigenous physical, mental, and spiritual health.82,86,101,102 This alteration in relationships occurs when individuals, families, and communities (within and between generations) are less able or not able to share traditional knowledges about the natural environment (such as where and when to harvest or hunt), food, and ceremonial or cultural objects, among other things, because the knowledge is no longer accurate or traditional foodstuffs and species are less available due to climate change. For many Indigenous peoples, the act of sharing is fundamental to these intra- and intergenerational relationships, sustains cultural practices and shared identity, and underpins subsistence practices.44,103 A projected health-related consequence of reduced or lost access to the knowledge, experiences, and relationships built on sharing is increased food insecurity for households reliant on subsistence practices.61 For example, in Alaska, changes in sea ice coverage and thickness and the timing of ice formation (Ch. 9: Oceans; Ch. 26: Alaska) can lead to decreased access to hunting and fishing areas, which can mean people are unable to access food sources (that is, loss of cultural use.81 This can then result in lost opportunity for the social components of these activities, including reduced community connection (e.g., Donatuto et al. 201481), less food and knowledge sharing, and diminished relationship building.44,61

Communities that rely on the natural environment for sustenance and livelihoods are at increased risk for adverse mental health outcomes related to climate change.104 Many Indigenous communities share a focus on relationships between people and wildlife and on a respect for natural resources.29,81,105 Climate impacts to lands, waters, foods, and other plant and animal species undermine these relationships, affect place-based cultural heritages and identities, and may worsen the historical trauma still experienced by many Indigenous peoples.86,101,102 For example, in Arctic Indigenous communities, changing wildlife and vegetation patterns are disrupting traditional and subsistence practices and have been associated with increased rates of mood and anxiety disorders; strong emotional responses; and loss of connections to homeland, social networks, and self-worth.82,101 Additionally, climate impacts that degrade water quality can adversely affect sacred water sources and aquatic species on which subsistence livelihoods and associated relationships are based, increasing the risk of mental health impacts in addition to the well-studied physical health concerns.53,71 Damage to cultural heritage sites from climate change can affect mental health through impacts to cultural, economic, and social relationships.106 Media imagery and reports or stories of climate risks and vulnerability also lead to psychological trauma or increased anger, anxiety, depression, fear, and stress.107 These impacts can intensify existing social stressors, such as loss of jobs and social connections, loss of social support, and family distress.101,104

Climate change adaptation measures can reduce physiological vulnerability to health risks; to date, most observational evidence comes from behavioral and public health responses to extreme heat.108,109,110,111 Organizations including the National Indian Health Board and the Alaska Native Tribal Health Consortium have ongoing efforts to increase Indigenous adaptive capacity specifically for health. Some tribes have climate vulnerability assessments that acknowledge the role of traditional subsistence species, or First Foods, as an essential aspect of health and tribal resilience; for example, the Yurok Tribe assesses the role of salmon in community health,112 and the Confederated Tribes of the Umatilla Indian Reservation60 discuss climate risks to salmon, elk, deer, roots, and huckleberry habitat (Ch. 24: Northwest, KM 2). In the Republic of the Marshall Islands, a community-led planning process known as Reimaanlok incorporates traditional knowledge and facilitates local self-determination to support shared goals of climate adaptation, natural resource management, and community health.85